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Children's Knee Pain: A Focus on Osgood-Schlatter’s Syndrome

There are few things worse than watching your child struggle with knee pain, especially if it is preventing them from playing the sports they love. While there are a number of different potential causes of knee pain in children, one we commonly see in late childhood to early adolescence is Osgood-Schlatter’s Syndrome (otherwise known as tibial apophysitis). While the name can be quite daunting, the condition is quite common and manageable. In this blog we will discuss what this syndrome is, why it causes children's knee pain, and how it can be effectively managed.

Understanding Osgood-Schlatter’s Syndrome?

Osgood-Schlatter’s Syndrome is a tractional apophysitis, a painful condition that occurs when the patella tendon pulls on the growth plate at the front of the shin bone, just below the knee. This site, otherwise known as the tibial tuberosity is the attachment point for the patella tendon and can become irritated with repeated stress or load.

The pain typically starts as a mild, nagging ache right over the bumpy area below the knee and tends to get worse when activity levels increase. There is often no preceding injury to the area and the pain develops spontaneously.

Rest will ease the pain, and it normally goes away within a few hours after stopping whatever activity or sport triggered it in the first place. Actions like running, jumping, bumping the knee, kneeling, and squatting tend to make the pain more noticeable. You might also notice a slightly raised, tender area where the kneecap tendon attaches below the knee.

What Causes Osgood-Schlatter’s Syndrome?

Many of the factors leading to knee pain in Osgood-Schlatter’s Syndrome are related to increased muscle tightness and load, increasing traction on the tibial tuberosity. These include:

Growth Spurts: As children grow, their bones grow faster than their muscles stretch. This can lead to tightness in the muscles, increasing the traction of tendons on their attachment points. The quadriceps tendon, linking the thigh muscles to the tibia, can pull on the growth plate at the top of the tibia, causing inflammation and pain in children's knees.

Physical Activities: Sports and activities that involve a lot of running, jumping, or sudden directional changes place a lot of load through the quadriceps and pull on the patella tendon, potentially leading to inflammation and development of Osgood-Schlatter’s Syndrome.

Age: Osgood-Schlatter’s Syndrome typically develops between the ages of 8 - 15 years old. While this is the typical age range, the condition will be limited by when the growth plate fuses which will vary between individuals.

How is Osgood-Schlatter’s Syndrome Diagnosed?

Osgood-Schlatter’s Syndrome is typically a clinical diagnosis based on pain presentation and functional assessments. If the pain experienced is unusual, X-ray or other imaging techniques may be used to rule out other conditions however this is typically not necessary.

Treatments for Osgood-Schlatter’s Syndrome

Osgood-Schlatter's Syndrome will typically self resolve when the growth plate fuses, however this can take a number of years. While waiting for this bone to fully develop, it is important to manage the causes of the pain to ensure your child remains comfortable and can continue to participate in activities and sports. These treatment options include:

Rest and Ice Application: Modifying activities to allow the knee to rest can reduce both pain and inflammation at the tibial tuberosity. Applying ice to the affected area after activity can also be beneficial for pain and swelling reduction.

Stretching and Release Work: Gentle stretching and release work such as massage and foam rolling can be beneficial in reducing the muscle tightness in the quadriceps and hamstrings. By reducing the muscle tension, there is less stress applied by the patella tendon to the tibia.

Custom Foot Orthotics: The position of the feet can significantly impact the position of the knees. We will commonly see children with very flat feet struggling with Osgood-Schlatter’s Syndrome due to their knees falling into a “knock knee” position. This changes the stress on the knee and can increase development of Osgood-Schlatter’s. Custom foot orthotics place the foot into a more neutral position, allowing the knees to sit straighter and decreasing pain.

Exercise Therapy: The quadricep muscle group is made up of four muscles (hence the name, quad-ricep). If certain muscles are stronger than others or pulling unevenly, this can irritate the growth plate where the tendon attaches. Exercise therapy to evenly strengthen the quadricep muscle group can help reduce some of the irritation associated with Osgood-Schlatter’s Syndrome. Appropriate development of the hamstring muscle groups can also reduce over activation and will often be incorporated into an exercise program.

Pain Management: Oral anti-inflammatory medications such as ibuprofen can help manage the inflammation and knee pain associated with Osgood-Schlatter’s Syndrome. Always consult a healthcare provider for appropriate medication and dosage.

If your child is complaining of knee pain, a thorough consultation with a healthcare provider is crucial for a correct diagnosis and effective treatment planning. Our team is here to help you navigate the complexities of children's knee pain and provide personalised care.

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